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Event and Contingency Insurance Application Form

Please fill in all the mandatory fields marked with *

Policy Currency*

Please specify the currency*

Details of Event

Event Name*

Type of Event*

Venue*

Country*

City*

Event Start Date and End Date*

Event Location*

Has this Event been held before?*

Please provide details of applicant's experience in organising events*

Cover Details

Type of Coverage Needed*

100% Event Gross Revenue*

100% Event Costs & Expenses*

100% Event net profit*

Adverse Weather Cover

(Fill in this section if event location is "Outdoors" or "Under temporary structures")

What proportion of the Event (in monetary terms) takes place outside or under temporary structures?*

Can the Event proceed in continuous moderate rain fall and wind speeds of up to 40 mph?*

Does the Event venue have any history of flooding or exposure to strong winds?*

Can the outdoor elements of the Event be relocated indoors, at no additional expense, in the event of bad weather?*

If the outdoor elements of the Event have to be cancelled due to weather, will the indoor elements still proceed?*

Has the Event been held at the same time of year and location in the past?*

Is the Event location within 100 metres of a lake, river or watercourse?*

Can the Event be delayed or postponed if bad weather renders it dangerous or impossible to proceed?*

If you have any additional comments regarding the outdoor elements of the Event, and its susceptibility to bad weather, please add them here.

Non Appearance Cover

Name of Key Individual(s)

Date of Birth

How will the Key Individual(s) travel to the event?

Is the Key Individual(s) contracted to appear at this event?

How long before the Event are they due to arrive?

Does the Key Individual(s) have any prior commitments which may affect their ability to attend the event?

Is a replacement available if the Key Individual(s) is unable to attend the event?

Does the Key Individual(s) suffer from any physical, mental or medical condition?

Is the Key Individual(s) undergoing any form of treatment, medical or otherwise?

Is the Key Individual(s) following any prescribed regimen, medical or otherwise?

Does the Key Individual(s) have any history of non appearance?

Is the Key Individual(s) a member of the Royal Family or a serving/former Head of State?

Simultaneous Non Appearance Cover

Are there 20 or more Participants in total?

​People

Public Liability

Tenancy Period

(from dd/mm/yyyy to dd/mm/yyyy)

Number of Attendees

Maximum No. of Attendees Per Day

Limit of Indemnity (HKD)

Does the Event include any of the following activities?

Bouncy Castles?

Creches?

Fairground Ride?

Do You provide, operate or control any of these activities or equipment yourselves?*

Please provide evidence of current PL & EL been obtained from the sub-contractors that provide, operate or control any of these activities or equipment*

Do any other activities need to be considered?

Do You have any U.S. assets?

Employer Liability

Note

Employers liability cover is only available if You are based in the UK.

Who is classed as an Employee?

1. Temporary employees (paid or unpaid)

2. Person(s) hired to, or borrowed by You

3. Labour master or labour only sub contractor or person(s) supplied or employed by them

4. Self employed person(s)

5. Volunteers or unpaid person(s)

6. Person undertaking study or work experience or youth training scheme

Details of the Employees at this Event

a) Managerial and clerical, employees who do not engage in manual labour

No. Of Employees

Payments in relation to this Event

b) Manual Employees

No. Of Employees

Payments in relation to this Event

Please describe duties of the employees

c) Labour only sub-contractors & self employed sub contractors supplying labour

No. Of Employees

Payments in relation to this Event

Please describe duties of the employees

d) Volunteers

No. Of Employees

Payments in relation to this Event

Please describe duties of the employees

Is there any claims for personal injury or damage to property by third parties or employees have been made against You in the past 5 years?*

Additional Information

Have all contractual arrangements necessary for the successful fulfilment of the event been made and confirmed?*

Has any Event(s) in which the You were involved (in managing) had any incident that could have resulted, or did result, in financial loss that would be covered under the proposed insurance?*

Are You aware of any matter, fact, circumstance or incident existing or threatened that could possibly affect the performance(s) or Event(s), and might result in a loss under this insurance?*

Have You, or any other person to which this insurance would apply, ever been declined insurance, or had any such insurance cancelled, or renewal refused, or had special terms imposed?*

Any other information?

Declaration

I/We (Proposer) declare that the information provided to M.G. Geraghty (Insurance Brokers) Limited and in all appending sections is true to the best of My/Our knowledge.

It is understood that the signing of this proposal does not bind you to complete or us to accept this insurance, but you agree that, should a contract of insurance be concluded, this proposal and any supporting information shall be incorporated into and form the basis of the contract.

NOTE: 

  1. A material fact is one likely to influence acceptance or assessment of this proposal by us.

  2. If you are in any doubt as to what constitutes a material fact. Please consult us.

Underwritten by syndicates 623 and 2623 at Lloyd's. Beazley Solutions Limited is a service company that is part of the Beazley group of companies. Beazley Solutions Limited has authority to enter into contracts of insurance on behalf of the Lloyd’s underwriting members of Lloyd’s syndicates 623 and 2623 which are managed by Beazley Furlonge Limited. Beazley Solutions Limited is an appointed representative of Beazley Furlonge Limited which is authorised and regulated by the UK Financial Services Authority (Firm Reference Number: 204896) in its capacity as insurer.

Conditions of Quotation

Any terms provided by Us as a result of non binding indication and any supporting information will be subject to:

 

1. Final acceptance by You and then Us prior to the quote expiry date shown in the non binding indication, after which the resulting insurance cannot be cancelled.

 

2. You undertaking to advise Us of any change in the supporting information or additional information that should be supplied to make this non binding indication current, occurring prior to the inception date of any insurance subsequently issued.

3. You having declared all material facts likely to influence a reasonable Underwriter in determining:

  1. whether or not to accept the risk,

  2. the premium

  3. the terms, conditions, exclusions and limitations

4. You, if acting on behalf of others, being deemed to have obtained and declared all the information provided after making enquiry of each of them.

  1. any intermediary(ies) acting on behalf of any parties referred to in 4, being deemed to have obtained and declared all the information provided after making inquiry of the party(ies) for whom they act

  2. You accepting the quotation doing so on behalf of all others and accepting responsibility for payment of the premium as detailed in 7 below

5. You undertaking that no other insurance has been purchased on this specific risk and none shall be without Our prior written approval; in the event of such approval being given, the terms, conditions, exclusions, limitations and premium set out in any non binding. 

 

6. You paying the premium with acceptance of the non binding indication. If (in accordance with 1 above) We do not accept the risk, the premium will be returned.

Details of Applicant

Full Name*

Corresponding Address

Phone Number*

Email*

Postal / Zip Code

Position Held

Successfully submitted!

Please fill in all the mandatory fields marked with *

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